Contemporary Management of Malignancies of the Parotid Gland: A State-of-the-Art Review.

Abstract

To provide a systematic update on the contemporary management of malignancies of the parotid gland (MPG), focusing on evidence-based practices and emerging therapeutics. PubMed literature search. A search protocol was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) process for articles published between August 1, 2019, and August 1, 2024. Primary exclusion criteria were non-English text, abstracts, and case reports/series. Secondary inclusion criteria were articles specific to MPG diagnosis, histology, outcomes, and management, including surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapy. A total of 1614 articles were identified, and 137 articles were included in the final review. Most studies on low-grade MPG found that surgery alone was noninferior to surgery and adjuvant radiotherapy for local control. Elective neck dissection provided survival benefits for high-grade, but not low-grade, MPG. Most MPG are chemotherapy-resistant. Adjuvant chemotherapy provides limited survival benefits while significantly worsening quality of life and, thus, should be used only in select patients. Immunotherapy and targeted therapies for markers, including HER-2, TRK, and androgen receptors, have shown promising results in the treatment of advanced MPG. Advances in the treatment of MPG have improved survival while minimizing treatment toxicity and improving quality of life. Future studies are needed to emphasize personalized oncologic treatment for patients with these rare malignancies.